MENTAL HEALTH

Zoloft (Sertraline HCl): Side Effects, Dosage, & More

April 7, 2020

Symptom Guides > Mental Health > Zoloft (Sertraline HCl): Side Effects, Dosage, & More

by

Dr. Chesney Fowler

Dr. Fowler is an emergency medicine physician and received her MD from George Washington University. She completed her residency in emergency medicine at Christiana Care Health System. In addition to her work at K Health, Dr. Fowler is a practicing emergency medicine physician in Washington, DC.

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Zoloft (sertraline HCl) is the fourteenth most prescribed medication in the United States. Nearly forty million Americans use Zoloft to relieve depression, improve their mood and energy, and increase their comfort in social situations. It also works to reduce panic attacks and the urge to perform repetitive compulsive tasks.

 

In this article I’ll explore:

• What Is Zoloft?
• Zoloft Generic Name
• Sertraline Uses
• How Does Sertraline Work?
• Before You Take Sertraline
• Sertraline Dosage
• Common Side Effects
• Sertraline Alternatives
• When to See a Doctor
• How K Health Can Help

What Is Zoloft?

Zoloft is a prescription-only antidepressant medication that belongs to the class of drugs called selective serotonin reuptake inhibitors (SSRIs). It works by blocking the removal of serotonin from the brain which then increases serotonin levels and helps balance chemicals in the brain that can affect our mood.

 

Zoloft Generic Name

Zoloft is a brand name for the generic drug called sertraline hydrochloride (HCl). It was first approved for medical use in 1991 by the U.S. Food and Drug Administration (FDA). The generic version of the drug became available in 2006 and is offered in both a tablet and liquid form.

 

Sertraline Uses

Sertraline is approved by the FDA for the treatment of:

 

 

 

Major depressive disorder

 

Major depressive disorder (MDD), also known as clinical depression, is a common and serious mood disorder that usually affects young adults, especially women, between the ages of 18-25. If you suffer with MDD, you continually feel sad and lose interest in daily activities that you used to enjoy. You may find it difficult to carry out everyday tasks and have the feeling that life is no longer worth living. You may also suffer from physical symptoms such as chronic pain or digestive issues.

 

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), to be diagnosed with major depressive disorder, you will have at least five of the following symptoms (including at least one of the first two symptoms listed) persistently almost every day for a minimum of two weeks:

 

  • Depressed mood
  • Noticeable loss of interest or pleasure in your usual activities
  • Significant/noticable change in weight and/or appetite
  • Slower thoughts and movements, and physical and emotional reactions (psychomotor retardation)
  • Fatigue or lack of energy
  • Feelings of excessive or inappropriate guilt or worthlessness
  • Difficulty thinking and concentrating, or indecisiveness
  • Suicidal thoughts, recurrent suicidal ideation, or a suicide plan or attempt

 

Over 7% of American adults have at least one major depressive episode a year.

 

 

Obsessive compulsive disorder

 

Obsessive compulsive disorder (OCD) is a condition where you become entangled in a cycle of obsessions and compulsions.

 

Obsessions are defined as repetitive, unwanted, and uncontrollable intrusive thoughts, images, or urges that trigger intensely distressing feelings, including the feeling that things need to be done ‘correctly’. Obsessions seen with OCD include obsessions related to contamination, losing control, fear of harm, perfectionism, religion, unwanted sexual thoughts, and more.

 

Compulsions are defined as behaviors you engage in to try and escape or abolish the obsessions and feel less distressed. Common compulsions include excessive washing and cleaning, checking, and repeating, as well as mental compulsions including mental reviewing, counting, praying, and others.

 

To be diagnosed with OCD, this cycle of obsessions and compulsions becomes so extreme that it takes up much of your time and prevents you from carrying out other activities you value and would like to do.

 

The FDA has approved the use of sertraline to treat OCD in adults and children aged 6-17 years.

 

 

Panic disorder

 

According to the DSM-5, panic disorder is considered to be an anxiety disorder where diagnosis is based on the following:

 

  • You experience unexpected panic attacks on a regular basis
  • At least one attack is followed by at least one month or feeling fearful of further attacks and accordingly trying to avoid situations that might induce an attack
  • The attacks are not due to the direct physiological effects of a drug, medication, or medical condition
  • The attacks are not better accounted for by another mental disorder

 

Panic attacks are categorized as expected and unexpected. Expected panic attacks are typically linked to a specific fear such as being afraid of heights, whereas unexpected panic attacks have no known triggers and appear to occur out of the blue.

 

According to DSM-5, a panic attack is characterized by four or more of the following symptoms:

 

  • Numbness or tingling sensations
  • Chills or hot flushes
  • Sensations of shortness of breath or smothering
  • A feeling of choking
  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feelings of unreality or being detached from oneself
  • Fear of losing control or going crazy
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Fear of dying

 

If you have fewer than four of the above symptoms, it is considered a limited-symptom panic attack.

 

 

Post-traumatic stress disorder

 

Post-traumatic stress disorder is caused by the experience of a traumatic situation or event such as an accident; being a victim or witness to a violent crime, war or terrorism, serious disease or natural disaster; or being a victim of physical or sexual abuse. Such a traumatic experience can cause you to feel intense fear, pain, or sorrow to the extent that you are fearful of serious harm or death. Afterwards you can relive these feelings to the extent that they may affect your daily activities and relationships.

 

Signs and symptoms of PTSD include:

 

  • Nightmares, flashbacks, bad memories, hallucinations
  • Feeling anxious, restless, or on edge
  • Trouble sleeping, feeling depressed
  • Feeling afraid, helpless, numb, or detached from others
  • Angry or violent outbursts
  • Avoiding things or people that remind you of the trauma
  • Negative feelings about yourself, feeling guilty

 

According to the DSM-5, PTSD is diagnosed when you have had all of the following criteria for at least one month:

 

  • You have seen, faced, or experienced an event that involved or threatened serious injury, sexual violence, near death, or death.

 

  • You have at least one constant symptom of re-experiencing the traumatic event.

 

  • You have at least one symptom of avoidance of trauma-related stimuli.

 

  • You have at least two negative changes to the way you think and your mood following the trauma.

 

  • You have at least two hyperarousal symptoms such as irritability, aggression, risky behavior, hypervigilance, trouble concentrating and sleeping.

 

  • Your symptoms cause distress and affect your daily activities, work, and relationships.

 

The DSM-5 specifies that the above criteria for PTSD are not caused by a medication side-effect or other illness.

 

It is estimated that nearly 3% of U.S. adults had panic disorder in the past year.

 

 

Social anxiety disorder

 

Social anxiety disorder, or social phobia, is the feeling of intense anxiety or fear of being judged, negatively evaluated or rejected in a social or performance situation. You may be concerned about acting or appearing visibly anxious, or being viewed as stupid, awkward, or boring. These worries can cause you to avoid social situations. You may also suffer from physical symptoms, such as a rapid heart rate, nausea, sweating, and even full-blown anxiety attacks. You understand that your anxiety and fear is excessive, yet you can feel powerless to prevent it and it can cause you to lose out on forming social and romantic relationships, completing your studies, and gaining a career.

 

If you think you may have social anxiety disorder, make sure you get professional medical advice. You can be treated with an effective medication, such as sertraline, and avoid possible alcoholism as a result of your social phobia. Unfortunately, fewer than 5% of the ~15 million American adults who suffer from this disorder seek an available and effective medical treatment.

 

 

Premenstrual dysphoric disorder

 

Premenstrual dysphoric disorder is when you can suffer from serious depression, irritability, and tension before menstruation. PMDD is a more severe form of premenstrual syndrome (PMS) and can prevent you from carrying out your normal activities and social interactions. In both PMDD and PMS, about five to eleven days before menstruation, you may suffer from a wide range of physical or emotional symptoms which will then cease once your period starts. It is clear that hormonal fluctuations are involved in these conditions but the specific causes are not yet known.

 

According to the DSM-5, PMDD is diagnosed when you have at least five of the following 11 symptoms, including at least one of the first four listed:

 

  • Marked lability (e.g., mood swings)
  • Marked irritability or anger
  • Markedly depressed mood
  • Marked anxiety and tension
  • Decreased interest in usual activities
  • Hypersomnia or insomnia
  • Difficulty in concentration
  • Physical symptoms (e.g., breast tenderness or swelling, joint or muscle pain, a sensation of bloating and weight gain)
  • Lethargy and marked lack of energy
  • Marked change in appetite (e.g., overeating or specific food cravings)
  • Feeling overwhelmed or out of control

 

How Does Sertraline Work?

Sertraline is one of a group of antidepressants called selective serotonin reuptake inhibitors or SSRIs. These drugs work to relieve depression by acting in the brain to increase the levels of a mood-enhancing neurotransmitter or chemical called serotonin. More specifically, SSRIs prevent the reuptake or absorption of serotonin by neurons (brain nerve cells) so that serotonin levels are increased.

 

Before You Take Sertraline

 

Sertraline should not be taken for any of its FDA approved uses without consultation with a doctor. You cannot take sertraline if you have an allergy or hypersensitivity to sertraline.

 

 

Other medical conditions

 

Before you take sertraline, your doctor will talk to you about your medical history and make sure that no other existing medical conditions or medications you have used or are using will affect your suitability for this medication. For instance, you cannot be prescribed sertraline, or your doctor will have you very carefully monitored, if you have or are at risk of:

 

  • Hyponatremia or a very low concentration of sodium in your blood

 

  • SIADH or the syndrome of inappropriate secretion of antidiuretic hormone

 

 

 

  • Angle closure glaucoma since sertraline can have an effect on your pupil size causing it to dilate more and potentially increase the pressure inside your eye

 

  • Kidney or liver disease since this can affect how well you can break down and eliminate sertraline from your body

 

  • Severe active bleeding or problems with your blood platelets working properly

 

 

Pregnancy and Zoloft

 

If you are pregnant let your healthcare provider know immediately. There are certain circumstances in which Zoloft may be continued during pregnancy. Zoloft is considered one of the safest options for depression for breastfeeding women.

 

 

Sertraline interactions

 

Sertraline can interact with various medications. These drug interactions can affect how well sertraline works for you and potentially cause serious but preventable side-effects.

 

You need to let your doctor know what other medications you are currently taking or have taken recently before you are prescribed sertraline. This is also true of over-the-counter (OTC) medications or off-the-counter supplements.

 

Do not use sertraline if you have taken a monoamine oxidase inhibitor (MAOI) in the last 14 days or are about to take an MAOI within the next 14 days because this can result in dangerously increased blood pressure and serotonin syndrome.

 

St. John’s wort is an herbal supplement used to treat depression and it should not be combined with sertraline or any other depression or anxiety medications. Other medications that can interact with sertraline and cause serious problems include:

 

  • Eliglustat
  • Flibanserin
  • Isocarboxazid
  • Lomitapide
  • Phenelzine
  • Pimozide
  • Procarbazine
  • Selegiline
  • Thioridazine
  • Tranylcypromine

 

 

Zoloft and alcohol

 

Avoid drinking alcohol with sertraline as this can also cause unpleasant but preventable side effects. Sertraline may impair your thinking and reactions so take extra care when driving or carrying out other activities where you need to be alert.

 

Sertraline Dosage

Sertraline is available as either an oral tablet or a liquid. You will need to take it once a day at the same time, either in the morning or evening. It can be taken with or without food. If taken as a liquid, make sure to measure it accurately with a dosing spoon or oral syringe and then dilute it in a drink such as water or juice.

 

Sertraline comes in the following strengths:

 

  • 25 mg tablets
  • 50 mg tablets
  • 100 mg tablets
  • 20 milligrams per liter of liquid

 

The following are the recommended dosages for sertraline. After the initial dose, your doctor can slowly increase your dose, if needed, until you reach the optimal dose for you.

 

  • Major depressive disorder: recommended daily dose = 50-200 mg; initial daily dose = 50 mg

 

  • Obsessive compulsive disorder: for adults and children aged 13-17 years: recommended daily dose = 50-200 mg; initial daily dose = 50 mg; for children aged 6-12 years: recommended daily dose = 50-200 mg; initial daily dose = 25 mg

 

  • Panic disorder: recommended daily dose = 50-200 mg; initial daily dose = 25 mg

 

  • Post-traumatic stress disorder: recommended daily dose = 50-200 mg; initial daily dose = 25 mg

 

  • Social anxiety disorder: recommended daily dose = 50-200 mg; initial daily dose = 25 mg

 

  • Premenstrual dysphoric disorder*: recommended daily dose = 50 mg; initial daily dose = 50 mg; maximum daily dose = 100 mg

 

*For intermittent dosing starting 14 days before your anticipated date of your period through to the first day of your period and repeated with each new cycle. For daily dosing, the maximum dose is 150 mg.

 

Store your medicine at room temperature away from moisture and heat.

 

 

What happens if I miss a dose?

 

Always take your medication according to your doctor’s instructions and what it says on the information sheet that comes with your tablets. If you miss a dose, take it as soon as possible. However, if it is nearly time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not try to compensate for your missed dose by taking a double dose.

 

 

How long does it take for Zoloft or sertraline to work?

 

You will see improvements in your energy, sleep, or appetite within the first two weeks of taking sertraline. This is a good sign that your medicine is working. However, it will take 6-8 weeks before you see improvements in relieving your depression or lack of interest in your daily activities.

 

Make sure that you complete regular follow-up appointments with your doctor to make sure you are continuing on the best dosage for you.

 

 

Can you stop sertraline cold turkey? Does sertraline cause withdrawal symptoms?

 

Do not stop taking sertraline, even if you feel better, without discussing it first with your doctor. If it is time to stop taking sertraline, discuss with your doctor on how to gradually reduce your dose first. Stopping your medication suddenly can cause you unpleasant withdrawal symptoms. These can include irritability, nausea, dizziness, vomiting, nightmares, headaches, and/or tingling prickly skin.

 

Common Side Effects

 

What are the most common side effects of Zoloft?

 

Common Zoloft or sertraline side effects include but are not limited to:

 

  • Nausea
  • Diarrhea
  • Headache
  • Dry mouth
  • Sweating
  • Nervousness
  • Feeling restless
  • Fatigue
  • Insomnia or trouble sleeping
  • Sexual dysfunction

 

These side effects will usually improve over the first week or two as you continue to take the medication. The exception to this are sexual side effects, such as problems with orgasm or ejaculatory delay.

 

 

Does Zoloft cause weight gain?

 

You may gain some weight when taking sertraline. It is not clear why this happens. Possible reasons are that SSRIs increase your appetite or that these drugs change your body’s metabolism so that it does not efficiently use the calories you take in with your food.

 

Sertraline Alternatives

Sertraline is not the ideal medication to treat everyone. For example, sertraline should not be taken by someone with a pre-existing medical condition or medication that would interact with sertraline.Talk with your doctor to see whether you can try other medications, various therapies such as cognitive-behavioral therapy, psychotherapy, acceptance and commitment therapy (ACT), or other ‘talk therapies’. Many people suffering from depression and other mood disorders find such therapies to be of great benefit.

 

 

Zoloft vs. Lexapro

 

Both Zoloft and Lexapro belong to the same drug class called selective serotonin reuptake inhibitors. Therefore, they both work in the brain in a similar manner to reduce depression and anxiety. However, Zoloft has more FDA approved uses including obsessive compulsive disorder in both adults and children, panic disorder, and premenstrual dysphoric disorder, while Lexapro is only used off-label for these conditions.

 

Both Zoloft and Lexapro have similar common side effects, similar drug-interactions (for instance, with MAOIs), and can cause unpleasant withdrawal symptoms if you abruptly stop taking them.

 

 

Zoloft vs. Prozac

 

Both Zoloft and Prozac are SSRIs and therefore have a similar way they work in the brain to reduce depression and other mood disorders. Both medications are FDA approved to treat MDD, OCD, PD, and PMDD. However, Prozac is also used to treat bulimia nervosa, while Zoloft can also treat PTSD and social anxiety disorder. These drugs are approved to treat adults who have these conditions but Zoloft can also treat children 6 years and above for OCD, while Prozac can treat children 8 years and above for MDD.

 

Both Zoloft and Prozac share common side effects, have similar drug-interactions (including with MAOIs), and should not be stopped suddenly which can cause unpleasant withdrawal symptoms.

 

As with all medications, some people may find one drug more suitable for them than another. In other words, it depends on each individual how they are going to react to a particular drug. Having said that, studies have found that both Zoloft and Prozac are generally similarly effective for treating clinical depression. However, one clinical trial found that Zoloft had a lower severity of side effects compared to Prozac with significantly fewer people withdrawing from Zoloft compared to those withdrawing from Prozac.

 

 

Zoloft vs. Xanax

 

Zoloft and Xanax are both used to treat anxiety disorders and panic attacks but they work differently in the brain. This is because they belong to two different drug classes; Zoloft is an SSRI, whereas Xanax is a benzodiazepine. This means that Zoloft works to increase the amount of mood-enhancing serotonin chemical in the brain, while Xanax acts to inhibit the effects of a chemical in the brain called GABA. Too much GABA is thought to cause anxiety and other mood disorders.

 

Both Zoloft and Xanax have various side effects in common but unlike Zoloft, Xanax can be addictive and cause serious dependency problems. Neither drug should be stopped suddenly so as to avoid unpleasant withdrawal symptoms.

 

When to See a Doctor

Clinical depression and other mood disorders do not need to take over your life. Your doctor can guide you to suitable and effective treatments. You will then feel much more in control and can live your life more enjoyably.

 

Once you are on sertraline, it is very important that your family and close friends are aware you’re taking this medication. This is because sertraline and other similar SSRI antidepressants can increase the risk of suicide thoughts or actions in young people aged up to 25 years when first taking an antidepressant. If you notice mood changes or suicidal ideation, especially in the beginning of treatment, notify your doctor or seek medical attention straight away.

 

If you are taking sertraline, be sure to get immediate emergency medical assistance if you have signs of a rare allergic reaction to sertraline. Look out for:

 

  • Skin rash or hives
  • Difficulty breathing
  • Swelling of your face, lips, tongue, or throat

 

In the rare case you have a serious side effect, call your doctor without delay. Serious side effects include:

 

 

  • Signs of low salt levels: headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady

 

  • Severe nervous system reactions: very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out

 

  • Signs of serotonin syndrome: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea

 

If you think you have overdosed on sertraline, call 911 or call Poison Control at 1-800-222-1222. Symptoms of overdose can include:

 

  • Sleepiness
  • Nausea or vomiting
  • Dizziness
  • High fever
  • Confusion
  • Rapid heartbeat
  • Agitation
  • Shakiness

 

How K Health Can Help

Anxiety and depression are among the most under-reported and under-treated diseases in America. Nearly 20% of adults in the US suffer from mental health illness and fewer than half receive treatment. Our mission is to increase access to treatment for those suffering in silence.

 

You can start controlling your anxiety and depression and get access to the medication you need with K. For $34/month get the medication delivered to your door plus unlimited doctor visits through the K Health app. Start your free assessment to see if you’re eligible.

“Nearly forty million Americans use Zoloft to relieve depression, improve their mood and energy, and increase their comfort in social situations”

Anxiety and depression medication delivered for $34/month. Start free assessment to see if you’re eligible.

by

Dr. Chesney Fowler

Dr. Fowler is an emergency medicine physician and received her MD from George Washington University. She completed her residency in emergency medicine at Christiana Care Health System. In addition to her work at K Health, Dr. Fowler is a practicing emergency medicine physician in Washington, DC.

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